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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Acute-on-chronic liver failure in a multi-ethnic Asian city: A comparison of patients identified by Asia-Pacific Association for the Study of the Liver and European Association for the Study of the Liver definitions
Anandraj Selva Rajoo, Seng-Gee Lim, Wah Wah Phyo, Thandar Tun, Yock-Young Dan, Yin-Mei Lee, How-Cheng Low, Kieron Lim, Poh-Seng Tan, Guan-Huei Lee
Anandraj Selva Rajoo, Seng-Gee Lim, Yock-Young Dan, Guan-Huei Lee, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
Seng-Gee Lim, Institute of Molecular and Cell Biology, ASTAR, Singapore 138668, Singapore
Seng-Gee Lim, Wah Wah Phyo, Yock-Young Dan, Yin-Mei Lee, How-Cheng Low, Kieron Lim, Poh-Seng Tan, Guan-Huei Lee, Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Thandar Tun, Department of Hepatology, Mandalay General Hospital, 30th St, Chan Aye Tharsan Township, Mandalay, Myanmar
Author contributions: Lee GH contributed to study conception and design; Selva Rajoo A, Lim SG, Phyo WW, Tun T, Dan YY, Lee YM, Low HC, Lim K, Tan PS and Lee GH contributed to data acquisition, data analysis, and interpretation; Selva Rajoo A contributed to the writing of the article; Lim SG and Lee GH contributed to editing, reviewing and final approval of the article.
Institutional review board statement: The study was reviewed and approved by the National Healthcare Group Domain Specific Research Board.
Informed consent statement: Informed consent has been obtained from all eligible patients who can provide informed consent.
Conflict-of-interest statement: There are no existing or potential conflicts of interest for any of the investigators participating in this study and their immediate family members.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guan-Huei Lee, MBBS, FRCP (Edin), PhD, Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Singapore 119228, Singapore. mdcleegh@nus.edu.sg
Telephone: +65-67725595 Fax: +65-67751518
Received: January 4, 2017
Peer-review started: January 7, 2017
First decision: March 13, 2017
Revised: July 23, 2017
Accepted: September 14, 2017
Article in press: September 15, 2017
Published online: October 8, 2017
AIM
To explore the applicability of the Asia-Pacific Association for the Study of the Liver (APASL) and European Association for the Study of the Liver (EASL) guidelines for acute-on-chronic liver failure (ACLF) in profiling patients and determining the outcome.
METHODS
Patients admitted to a tertiary hospital in Singapore with acute decompensation of liver disease from January 2004 to July 2014 are screened for ACLF according to the APASL and EASL criteria. The patients’ data (including basic demographics, information about existing chronic liver disease, information about the acute decompensation, relevant laboratory values during admission, treatment, and outcome) are retrospectively analyzed to determine the background, precipitating factors and outcome.
RESULTS
A total of 458 liver patients is analyzed, and 78 patients with ACLF are identified. Sixty-three patients (80.8%) meet the APASL criteria, 64 patients (82.1%) meet the EASL criteria, and 49 patients (62.8%) fulfilled both criteria. The most common causes of acute liver injury are bacterial infections (59.0%), hepatitis B flare (29.5%), and variceal bleeding (24.4%). The common aetiologies of the underlying chronic disease included hepatitis B (43.6%), alcoholic (20.5%) and cryptogenic (11.5%) liver disease. The overall mortality rate is 61.5%. Increased age, the number of organ failures (as per CLIF-SOFA score), peak creatinine, INR, and amylase levels are associated with increased mortality or the need for liver transplantation. 14.3% of patients undergo liver transplantation with a 100% 1-year survival rate.
CONCLUSION
Both APASL and EASL criteria have identified ACLF patients with high three-month mortality, but those who fulfill APASL criteria alone have a better survival.
Core tip: Acute-on-chronic liver failure (ACLF) is a distinct disease entity with a high short-term mortality. Utilizing both the Asia-Pacific Association for the Study of the Liver (APASL) and European Association for the Study of the Liver criteria, our study shows that the clinical profile of ACLF patients in Singapore appears to have mixed features compared with similar studies reported in the rest of Asia and the West. Patients with ACLF fulfilling only the APASL criteria in our study had significantly better survival rates. We also analyzed the prognostic factors of ACLF in our study.
